CALCIPHYLAXIS IN A CHRONIC-HEMODIALYSIS PATIENT WITH PROTEIN-S DEFICIENCY

Vascular calcifications are common in uremic patients whereas calciphy laxis is rare. We report the case of a 45-year-old woman on chronic he modialysis since 1977. She had a subtotal parathyroidectomy in 1985, a ortic and mitral valve replacement in 1986, and has been treated since then with nicoumalone. In June 1991, she presented with repeated, pai nful cutaneous necrosis suggesting panniculitis. A skin biopsy showed lobular panniculitis and evidence of calciphylaxis. There was an obvio us biological hyperparathyroidism. Protein C functional level was in t he normal range whereas protein S functional level was low, i.e. 42%. The patient underwent cervical surgery to remove two parathyroid gland s, and daily hemodialysis sessions. Despite this treatment, cutaneous necrosis progressed with superinfection. A few weeks later, the patien t died from a septic shock after a myocardic infarction. Necropsy was not performed.